Stages of grief are natural when loved one is dying

Q: Our family is reeling from a cancer diagnosis given to my father.
The nurse told us that we’d go through different stages of handling my
father’s end-of-life care. I’d like to get a better understanding of
those stages. Can you help?

A: None of us is truly prepared for what we’ll feel and do when a loved
one is given a life-ending diagnosis. Even the life of a centenarian
feels short when the one you love is an integral part of your life. But
it does help to know how to navigate your own emotional journey.

I imagine your father’s nurse was referring to the most well-known
description of what people feel when they are confronted with a
life-ending illness by psychiatrist Elizabeth Kubler-Ross. In her
groundbreaking book, “On Death and Dying,” she introduced what is now
known as the five stages of the grief cycle or five stages of loss.
Besides death, grief also is a psychological response to other emotional
trauma such as divorce, loss of job or a major catastrophe such as
9/11.

You, your family and your father might go through one or all of
these stages, and you’ll surely go through them at your own pace.
Kubler-Ross never meant for the stages to be taken literally. We don’t
go through them step by step or in the order she presents them. Some of
us move in and out of various stages, some remain trapped in one, others
revisit them, and some might skip stages altogether.

But all in all, her model provides a worthy guide based on years of
study and experience that might help you better understand and
appreciate the barrage of emotions coming your way.

Kubler-Ross’ model is sometimes referred to by the acronym DABDA,
which stands for denial, anger, bargaining, depression and acceptance.
According to her stages, here’s how emotions play out when coping with
grief:

1. Denial: “I’m OK. This really isn’t happening to me.”

Denial is a natural reaction to information that’s catastrophic and
life changing. It’s the mind’s buffer to a terrible reality allowing you
a “time-out” and a chance to re-group. Because the reality can’t be
escaped when it comes to dying and death, it serves as a temporary
defense against an impending crisis.

2. Anger: “Why me? It’s just not fair!”

By the mere act of asking this question, it’s apparent that an
individual is no longer in denial. But the reality makes the person
angry, volatile and upset. The person might displace his anger by
finding fault with others, act out against any form of treatment or turn
inward and blame themselves. You’ll need to be understanding and allow
your loved one to vent his anger without taking it personally. It’s a
trying stage for everyone.

3. Bargaining: “If I make amends or do something good, then maybe I can buy more time.”

It starts with an internal conversation between one’s self and
whomever the person believes is her God or higher power. She hopes that
if she takes certain favorable actions, then she will be rewarded with
more time or beat the odds of dying altogether. It’s not uncommon for
the bargaining to be linked with surviving long enough to attend a
significant life event such as a daughter’s wedding, the birth of a
grandchild or the completion of a major project.

4. Depression: “I’m so incredibly sad. Why go on?”

During this fourth stage, the dying person begins mourning his own
death and the loss of all he knows. Some experts refer to this as
“anticipatory grief.” Regret, fear, crying and wanting to be alone are
all psychological responses that can be expected. It is a heartbreaking,
necessary process and not something you can simply treat with cheerful
encouragement.

5. Acceptance: “It’s my time, and I’m OK with it.”

Reaching this stage is expressed in as many ways as there are
fingerprints. But underneath it all is a deep sense of having come to
terms with one’s mortality. For some, it might take the form of a sense
of peace and calm, while others see it as their fate and see no reason
to fight it. It’s not unusual for the dying person to reach this stage
long before his family members. As a result, it might appear to those
who are still struggling that their loved one has become emotionally
detached.

It’s no wonder why such a daunting, life-changing event runs the
gamut of emotions and why it’s so unlikely, that you and your family
will be on the same page throughout it. Many liken it to a
roller-coaster ride and there’s no getting off. Be patient with one
another. If someone is angry, let the person express it, and don’t take
it personally. If another is in denial, let the person remain in her
“unrealistic” cocoon until she’s ready to cope with the harsh reality
that lies ahead. Grieving is natural. Don’t suffocate it by avoiding the
sadness and pain that comes with loss.

Hospice care can be a compassionate and learned resource for all of you. Be sure to seek it out.

Correction: A few weeks ago, we discussed how to find a board-certified
physician in geriatrics. The correct website for the American Board of
Family Medicine, which offers consumers a registry of geriatricians is
www.theabfm.org. My apologies for accidentally sending you to a finance
group.

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